Corticosteroids plus IVIg may lower death risk in patients with SJS/TEN overlap

Treatment with corticosteroids in combination with intravenous immunoglobulin (IVIg) is associated with a reduction in mortality risk among patients with Stevens-Johnson syndrome (SLS) and toxic epidermal necrolysis (TEN) overlap and TEN, a recent study has shown.

“Various systemic immunomodulating therapies have been used to treat TEN, but their efficacy remains unclear,” the investigators said.

A systematic review and network meta-analysis was carried out to assess the effects of systemic immunomodulating therapies on mortality for SJS/TEN overlap and TEN. Online databases were searched from inception to 31 October 2019. Mortality rates and Score of Toxic Epidermal Necrolysis (SCORTEN)-based standardized mortality ratio (SMR) were the primary outcomes. Finally, a frequentist random-effects model was adopted.

Sixty-seven studies involving 2,079 patients met the eligibility criteria. A network meta-analysis of 10 treatments demonstrated that none was superior to supportive care in reducing the rates of death and that thalidomide correlated with a significantly higher mortality rate (odds ratio, 11.67, 95 percent confidence interval [CI], 1.42–95.96).

For SMR, a network meta-analysis of 11 treatment arms revealed that the combination therapy of corticosteroids and IVIg was the only treatment associated with significant survival benefits (SMR, 0.53, 95 percent CI, 0.31–0.93).

“Cyclosporine and etanercept are promising therapies, but more studies are required to provide clearer evidence,” the investigators said.

The study was limited by heterogeneity and a small number of eligible randomized controlled trials.